Turk Kardiyol Dern Ars. 2012; 40(4): 323-330 | DOI: 10.5543/tkda.2012.59144

Comparison of long term clinical outcomes, event free survival rates of patients undergoing enhanced external counterpulsation for coronary artery disease in the United States and Turkey

Ozlem Soran¹, Coskun İkizler², Atilla Sengul³, Bilal Çuğlan⁴, Elizabeth Kennard⁵, Sheryl Kelsey^5
1University of Pittsburgh, Heart And Vascular İnstitute 200 Lothrop Street Presbyterian Hospital, Upmc, 7th Floor, F-748 Pittsburgh, Pa, 15044 Usa
²Department of Cardiovascular Surgery, Medical School, Ufuk University, Ankara, Turkey
³MEDKAR Heart Diagnosis And Treatment Center, Ankara, Turkey
⁴Department of Cardiology, İnönü University, Turgut Özal Medical Center, Malatya, Turkey.
⁵Department of Epidemiology, Graduate School of Public Health, University Of Pittsburgh, Pittsburgh, Pennsylvannia, Usa

OBJECTIVES
This study assessed the long-term efficacy of EECP (Enhanced External Counterpulsation) in Turkish (TR) patients initially and compared these results with the United States (US) in a real world setting.

STUDY DESIGN
In this study, 2072 patients were treated and followed in the US and 82 patients were treated and followed in TR. The International EECP Patient Registry Phase I and II was initiated and coordinated at the University of Pittsburgh. The aim of the “registry” was to assess the outcomes of clinical trials in a real world setting. Another unique feature of this study was to enroll patients not only from university hospitals but also from private hospitals, educational hospitals, and treatment centers.

RESULTS
TR patients had less diabetes, hypertension, and hyperlipidemia than US patients (p<0.01). TR patients also had a higher proportion of diastolic augmentation (p<0.001). Both groups showed a significant reduction in the severity of angina after a 35h EECP course (p<0.001). Major Adverse Cardiac Events (MACE) rate (death, coronary artery bypass graft, percutaneous coronary intervention, myocardial infarction) was low in both groups during treatment (2.5% vs. 2.7%). At 1 year follow up, 84% of TR and 76% of US patients had maintained the improvement of angina.

CONCLUSION
Patients presenting for EECP treatment from TR had different baseline profiles from US patients. However, despite the high risk baseline characteristics, both cohorts achieved similar reduction in angina. In the long term follow-up, the MACE rate was low and the improvement after EECP was sustained in most of the patients.

Keywords: Aged, angina pectoris/mortality/therapy, coronary artery disease/epidemiology, counterpulsation/methods, enhanced external counterpulsation; follow-up studies; heart failure/epidemiology; registries; treatment outcome; Turkey/epidemiology

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